LEGISLATION AND REGULATIONS - WHAT IS REQUIRED?

Notification required by state

Currently 30 states require some level of breast density notification after a mammogram (not including Indiana's law).

5 states have efforts for breast density reporting/education that do not require notification.

Though some state laws are more similar than others, there is no standard from state-to-state on what patients are told or how patients will be informed.

Insurance Coverage – Denoted by a on the map

If there is a state insurance law, are all women covered? NO. A state insurance law does not necessarily apply to all policies within the state. Further, national insurance providers may be exempt from state laws.

If there is no state insurance law, or if a plan is exempt from state law, might additional testing be covered? YES. While indicated states have some level of insurance coverage, generally, in other states, additional screening will be covered (subject to deductible/copay) if ordered by a physician.

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal.
However, dense breast tissue may make it harder to find cancer on a mammogram and may also be associated with an increased risk
of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information
to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful,
based on your risk. A report of your results was sent to your physician."

ARIZONA:

Effective date: 10/1/2014

Who receives:
Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed:
In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in fifty percent of women.
However, dense breast tissue can make it more difficult to detect cancers in the breast by mammography and may also be associated with an
increased risk of breast cancer. This information is being provided to raise your awareness and to encourage you to discuss with your health
care providers your dense breast tissue and other breast cancer risk factors. Together, you and your physician can decide if additional screening
options are right for you. A report of your results was sent to your physician."

CALIFORNIA:

Effective date: 4/1/2013 and remains in effect through 1/1/2019 unless extended by law

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can
make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer.
This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with
your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician."

CONNECTICUT:

Effective date: 10/1/2009

Who receives: Women who have heterogeneous or extremely dense breast tissue.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening or a breast MRI examination, or both, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this report."
Insurance: Both individual and group health insurance policies shall provide benefits for comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates (1) heterogeneous or dense breast tissue or (2) if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by a woman’s physician or advanced practice registered nurse. Benefits must also include magnetic resonance imaging of an entire breast or breasts in accordance with guidelines established by the American Cancer Society.
No policy shall impose a copayment that is more than $20 for such ultrasound screening. Deductible is subject to the patient’s health care plan.
Expanded Mammography Coverage: Beginning 1/1/2017, state law will require insurance companies to provide coverage for 3D mammograms; however, not all insurance policies are required to comply. Check with your insurance company regarding details of your coverage.

Delaware:

Effective date: 12/21/2015

Who receives: All patients. Every patient will be provided information about their own breast density.
How Informed: In the letter sent to patients after their mammogram.
Notification required:
None specifically required, however Delaware mammography facilities have been provided sample wording to use based on guidelines from the American College of Radiology (ACR). The notification will include the patient’s breast density based on the ACR Breast Imaging Reporting and Data System (BI-RADS), and awareness statements about breast density. It will also include notice to patients to use this information to guide discussions about screening with their referring physicians.

GeorgiaBill Number: HB 324

A bill was introduced but did not progress and/or pass into law by end of the 2016 legislative session.

HAWAII:

Effective date: 1/1/2014

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However,
dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast
cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk
to your physician as to whether, based on your risk, more screening tests might be useful. A report of your results was sent to your
physician."

ILLINOIS:

Notification: No law that either requires or suggests density notification.
Education: A law was passed which directs, from funds made available for this purpose, publication of a summary outlining methods for the early detection and diagnosis of breast cancer. The brochure is to include the meaning and consequences of "dense breast tissue" under the guidelines of the Breast Imaging Reporting and Data System of the American College of Radiology. The Illinois Department of Health is to make the brochure available to the public. Effective date 1/1/2014.
Insurance: If a routine mammogram reveals heterogeneous or dense breast tissue, coverage must provide for a comprehensive ultrasound screening of an entire breast or breasts, when determined to be medically necessary by a physician. The required coverage for mammograms and ultrasound screenings must be provided at no cost to the insured (i.e., co-pays or deductibles may not be applied) if a preferred provider is utilized. The cost of the mammogram or screening must not count against any annual or lifetime benefit limits contained in the insurance policy or HMO contract. If an out-of-network provider provides the mammogram or screening, the cost-sharing prohibition does not apply. However, the insurance company or HMO must provide coverage that is at least as favorable as out-of-network coverage for other radiological examinations.
Expanded Mammography Coverage: State law requires insurance companies to provide coverage for 3D mammograms; however, not all insurance policies are required to comply. Check with your insurance company regarding details of your coverage.

Indiana

Effective date: 7/1/16

Who receives: Unclear. Law specifies that if imaging facility determines patient has "an amount of breast and connective tissue in comparison to fat in the breast," the facility shall notify the patient of the determination. However, imaging facilities are not required to make a determination of the amount of breast and connective tissue in comparison to fat in the breast. Further, all breasts have an amount of breast/connective tissue in comparison to fat.
How informed: In the letter sent to patients after their mammograms.
Notification required: Not specified. The law only requires a patient be told they have "an amount of breast and connective tissue in comparison to fat in the breast." The law does not provide specific guidelines, suggest/recommend reporting language or require that a patient be provided information about personal breast density or breast density in general.
PLEASE NOTE: State legislative language can be vague or complex and is open to interpretation. For interpretation from the Medical Licensing Board of Indiana click HERE

Insurance: A state employee health plan, an individual contract or group contract for insurance that provides coverage for basic health care services, and a policy of accident and sickness insurance must each provide coverage for appropriate medical screening, test, or examination for a female insurance enrollee who is at least forty (40) years of age and who has been determined to have high breast density. High breast density means a condition in which there is a greater amount of breast and connective tissue in comparison to fat in the breast. Additional screening subject to the copay and deductible of patient’s health care plan.

There are exceptions to this coverage. No coverage is required for the following types of insurance:
(1) Accident only, credit, dental, vision, Medicare supplement, long-term care, or disability income insurance.(2) Coverage issued as a supplement to liability insurance.(3) Automobile medical payment insurance.(4) A specified disease policy.(5) A short term insurance plan that:a. may not be renewed; andb. has a duration of not more than six (6) months.(6) A policy that provides indemnity benefits not based on any expense incurred requirement, including a plan that provides coverage for:a. hospital confinement, critical illness, or intensive care; orb. gaps for deductibles or copayments.(7) Worker's compensation or similar insurance.(8) A student health plan.(9) A supplemental plan that always pays in addition to other coverage.(10) An employer sponsored health benefit plan that is:a. provided to individuals who are eligible for Medicare; andb. not marketed as, or held out to be, a Medicare supplement policy.

Iowa:

Effective date: Patient reporting language must be developed by 1/1/2018

Who receives: Every patient must receive information that identifies the patient's individual breast density classification (fatty, scattered, heterogeneously dense or extremely dense).
How informed: In the letter sent to patients after their mammogram.
Notification required:
Language to be developed to be sent to a patient with heterogeneously dense or extremely dense breast tissue. "The report to the patient shall include evidence-based information on dense breast tissue, the increased risk associated with dense breast tissue, and the effects of dense breast tissue on screening mammography."

Kentucky:

Effective date: 7/3/2017 (estimated) and in effect through 1/1/2021 unless extended by law

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your x-ray mammogram shows that your breast tissue is dense. Dense breast tissue is common among women and is not abnormal. However, women with dense breast tissue may have a slightly increased risk for developing breast cancer. Dense breast tissue may also make it more difficult to detect an early breast cancer on your x-ray mammogram. At this time, there are no specific recommendations for additional screening or other measures related to having dense breast tissue. However, you may want to talk to your doctor about other ways that you might be able to reduce your risk of breast cancer. A report of your results was sent to your ordering physician. If you are self-referred, a report of your results was sent to you in addition to this summary."
Expanded Mammography Coverage: State law expands definition of "mammogram" to include digital mammography including breast tomosynthesis (3D mammograms).
Check with your insurance company regarding details of your coverage.

LOUISIANA:

Effective date: 1/1/2016

Who receives: All patients. This law does not require women be provided information as to whether they have dense breasts. Patients with and without dense breasts receive the same notification.
How informed: In a letter sent to patients after their mammogram.
Notification required:
"If your mammogram demonstrates that you have dense breast tissue, which could hide abnormalities, and you have other risk factors for breast cancer that have been identified, you might benefit from supplemental screening tests that may be suggested by your ordering physician. Dense breast tissue, in and of itself, is a relatively common condition. Therefore, this information is not provided to cause undue concern, but rather to raise your awareness and to promote discussion with your physician regarding the presence of other risk factors, in addition to dense breast tissue. A summary of your mammography results will be sent to you, and a full mammography report will be sent to your physician and also to you. You should contact your physician if you have any questions or concerns regarding your summary or report of results."

This bill was introduced in the 2017 legislative session, but did not progress and/or pass into law. However, in 2012, a state Work Group was formed to
discuss the issue. The Group recommended Maine radiologists voluntarily communicate information about breast density to women with heterogeneously or
extremely dense breasts in the letter sent to them after their mammograms.
The Work Group suggested radiologists may use or adapt the following language:
"The mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. But dense breast tissue can make it harder to
find cancer on a mammogram. Also, dense breast tissue may increase your breast cancer risk. This information about the result of your mammogram report is
given to you to raise your awareness. Use this report when you talk to your doctor about your own risks for breast cancer, which includes your family
history. At that time, ask your doctor if more screening tests might be useful, based on your risk."

MARYLAND:

Effective date: 10/1/2013, amendment effective 10/1/2017

Who receives: All patients. This law does not require women be provided information as to whether they have dense breasts. Patients with and without dense breasts receive the same notification.
How informed: In the letter sent to patients after their mammogram.
Notification required thru 9/30/17:
"This notice contains the results of your recent mammogram, including information about breast density.
If your mammogram shows that your breast tissue is dense, you should know that dense breast tissue is a common finding and is not abnormal, with about half of women having dense or highly dense breasts. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of cancer.
This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your physician. Together, you can decide which screening options are right for you based on your mammogram results, individual risk factors, or physical examination. A report of your results was sent to your physician."
Notification required effective 10/1/2017:
"This notice contains the results of your recent mammogram, including information about breast density.
If your mammogram shows that your breast tissue is dense, you should know that dense breast tissue is a common finding and is not abnormal, with about half of women having dense or highly dense breasts. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of cancer.
This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your physician. Together, you can decide whether additional screening options are right for you based on your mammogram results, individual risk factors, or physical examination. A report of your results was sent to your physician."
Expanded Mammography Coverage (effective 1/1/2018): State law requires insurance companies to provide coverage for digital tomosynthesis (3D mammograms). Check with your insurance company regarding details of your coverage.

Massachusetts:

Effective date: 1/1/2015

Who receives: Patient whose mammogram indicates dense tissue.
How informed: In the letter sent to patients after their mammogram.
Notification required:
There is no mandatory language that must be included. However, the notification has to include, at the minimum:
(1) that the patient’s mammogram shows dense breast tissue;
(2) that the degree of density apparent and an explanation of that degree of density;
(3) that dense breast tissue is common and not abnormal but that dense breast tissue may increase the risk of breast cancer;
(4) that dense breast tissue can make it more difficult to find cancer on a mammogram and that additional testing may be needed
for reliable breast cancer screening;
(5) that additional screening may be advisable and that the patient should discuss the results of the mammogram with the
patient’s referring physician or primary care physician;
(6) that the patient has the right to discuss the results of the patient’s mammogram with the interpreting radiologist
or the referring physician;
(7) that a report of the patient’s mammogram has been sent to the referring physician and will become part
of the patient’s medical record; and
(8) where the patient can find additional information about dense breast tissue.

MICHIGAN:

Effective date: 6/1/2015

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However,
dense breast tissue can make it harder to find cancer through a mammogram. Also, dense breast tissue may increase your risk for breast cancer.
This information about the result of your mammogram is given to you to raise your awareness. Use this information to discuss with your health
care provider whether other supplemental tests in addition to your mammogram may be appropriate for you, based on your individual risk. A report
of your results was sent to your ordering physician. If you are self-referred, a report of your results was sent to you in addition to this summary."

MINNESOTA:

Effective date: 7/1/2014

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammogram. The letter must include notice that the patient has dense tissue,
that this may make it more difficult to detect cancer on a mammogram, and that this may increase her risk of breast cancer.
Notification which may be used:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is relatively common and is found in more than 40
percent of women. However, dense breast tissue may make it more difficult to identify precancerous lesions or cancer through a mammogram
and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you
to raise your own awareness and to help inform your conversations with your treating clinician who has received a report of your mammogram results.
Together you can decide which screening options are right for you based on your mammogram results, individual risk factors, or physical examination."

This bill was introduced in the 2017 legislative session and signed into law, however the amended/final language did not include any specific mention of/about breast density or requirement for density notification.

MISSOURI:

Effective date: 1/1/2015

Who receives: All patients, regardless of breast density. This law does not require women be provided information as to whether they have dense breasts.
How informed: While the law requires notification to be provided to the patient after her mammogram, it does not state how.
Most other state laws, for instance, specifically require breast density information to be included in the letter sent to patients
after their mammogram.
Notification required:
"If your mammogram demonstrates that you have dense breast tissue, which could hide abnormalities, and
you have other risk factors for breast cancer that have been identified, you might benefit from supplemental screening
tests that may be suggested by your ordering physician. Dense breast tissue, in and of itself, is a relatively common condition.
Therefore, this information is not provided to cause undue concern, but rather to raise your awareness and to promote discussion
with your physician regarding the presence of other risk factors, in addition to dense breast tissue. A report of your mammography
results will be sent to you and your physician. You should contact your physician if you have any questions or concerns regarding this report."

NEVADA:

Effective date: 1/1/2014, but notification language amended to the following effective 7/1/2015

Who receives: All patients. Every patient must receive a statement of the category of their own breast density. Patients with "dense" breasts must also receive the notification below.
How informed: In the letter sent to patients after their mammogram.
Notification required: "Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your physician. Together, you can decide which screening options are right for you. A report of your results was sent to your physician."

NEW JERSEY:

Effective date: 5/1/2014

Who receives: All patients, regardless of breast density. This law does not require women be provided information as to whether they have dense breasts.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram may show that you have dense breast tissue as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology. Dense breast tissue is very common and is not abnormal. However, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider. A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology, www.acr.org."
Insurance: No medical or health service corporation contract or health insurance policy and every individual and small employer health benefit and health maintenance organization providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting an ultrasound evaluation, a magnetic resonance imaging scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts, after a baseline mammogram examination, if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or if the patient has additional risk factors for breast cancer including but not limited to family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology and Data System established by the American College of Radiology, or other indications as determined by the patient’s health care provider. Additional screening subject to the copay and deductible of patient’s health care plan.

Please note, employer plans set up as "self funded" (check with your benefit administrator) do not, generally, have to comply with state insurance laws.

NEW YORK:

Effective date: 1/19/2013

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer.
This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician."
Insurance:
The law became effective 1/1/2017. In part, it amends/adds the following to current insurance law: "Screening and diagnostic imaging for the detection of
breast cancer, including diagnostic mammograms, breast ultrasounds, or magnetic resonance imaging, covered under the policy shall not be subject to annual
deductibles or coinsurance." "The requirement only applies with respect to participating providers in the insurer’s network, or with respect to non-
participating providers, if the insurer does not have a participating provider in the in-network benefits portion of its network with the appropriate
training and experience to meet the particular health care needs of the insured."
A further action clarified "Tomosynthesis is a screening and diagnostic imaging tool for the detection of breast cancer that is covered by these provisions.
Therefore, an issuer must cover tomosynthesis, when medically necessary, without being subject to annual deductibles or coinsurance."
Please note, employer plans set up as "self funded" (check with your benefit administrator) do not, generally, have to comply with state insurance laws.

NORTH CAROLINA:

Effective date: 1/1/2014

Who receives: Every patient must receive information that identifies the patient's individual breast
density classification (fatty, scattered, heterogeneously dense or extremely dense). Patients with heterogeneously or extremely
dense breasts must receive the notification below.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram indicates that you may have dense breast tissue. Dense breast tissue is relatively common and is
found in more than forty percent (40%) of women. The presence of dense tissue may make it more difficult to detect abnormalities
in the breast and may be associated with an increased risk of breast cancer. We are providing this information to raise your awareness
of this important factor and to encourage you to talk with your physician about this and other breast cancer risk factors. Together, you
can decide which screening options are right for you. A report of your results was sent to your physician."

NORTH DAKOTA:

Effective date: Signed into law 4/8/15 and was in effect until 7/31/17. The law has since expired.

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammogram.
Notification:
The summary of the written report that is sent to the patient shall include notice that the patient has dense breast tissue, that this dense breast tissue may make it more difficult to detect cancer on a mammogram, and that this dense breast tissue may increase the patient’s risk of breast cancer.

OHIO:

Effective date: 3/19/2015

Who receives: Women whose mammogram indicates dense tissue
How informed: In the letter sent to patients after their mammograms
Notification required:
"Your mammogram demonstrates that you have dense breast tissue, which could hide abnormalities. Dense breast
tissue, in and of itself, is a relatively common condition. Therefore, this information is not provided to cause undue concern;
rather, it is to raise your awareness and promote discussion with your health care provider regarding the presence of dense breast
tissue in addition to other risk factors."

OKLAHOMA:

Effective date: 11/1/2016

Who receives: Every patient must receive information that identifies the patient's individual breast density classification. Patients with heterogeneously or extremely dense breasts must receive the notification below.
How informed: In the letter sent to patients after their mammograms.
Notification required:
"Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in more than fifty percent (50%) of women and is not abnormal. However, dense breast tissue may make it more difficult to detect breast cancer and may be associated with an increased risk of breast cancer. This information is being provided to raise your awareness and to encourage you and your health care provider to discuss this and other breast cancer risk factors. Together, you and your health care provider can decide if additional screening options may be right for you. A report of your results was sent to your health care provider."

OREGON:

Effective date: 1/1/2014

Who receives: Notification is required to only those patients who have extremely dense breasts. For patients with heterogeneously dense breasts,
the decision of whether or not to send the patient notification is left to the interpreting radiologist.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"Your mammogram shows that your breast tissue is dense. For most women, breast density decreases with age, but in some women,
there is little change. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a
mammogram and may also be associated with an increased risk of breast cancer. This information is provided to you by Oregon State Law to
raise your awareness and to promote discussion with your health care provider about your own risk for breast cancer. Together, you can decide
if additional breast imaging tests such as a breast ultrasound, Magnetic Resonance Imaging (MRI) or Breast-Specific-Gamma-Imaging (BSGI) would be
beneficial based on your risk factors and physical examinations. A report of your results was sent to your health care provider."

PENNSYLVANIA:

Effective date: 1/30/2014

Who receives: All patients will receive information about their individual breast density and all
patients receive the required notification below.
How informed: In the letter sent to patients after their mammogram.
Notification required:
"This notice contains the results of your recent mammogram, including information about breast density.
If your mammogram shows that your breast tissue is dense, you should know that dense breast tissue is a common finding and is
not abnormal. Statistics show many patients could have dense or highly dense breasts. Dense breast tissue can make it harder to
find cancer on a mammogram and may be associated with an increased risk of cancer. This information about the result of your mammogram
is given to you to raise your awareness and to inform your conversations with your physician. Together, you can decide which screening
options are right for you, based on your mammogram results, individual risk factors or physical examination. A report of your results was
sent to your physician."
Expanded Mammography Coverage: State law requires insurance companies to provide coverage for 3D mammograms; however, not all insurance policies are required to comply. Check with your insurance company regarding details of your coverage.

RHODE ISLAND:

Effective date: 10/1/2014

Who receives:
All patients. Every patient will be provided information that identifies the patient's individual breast tissue
classification (fatty, scattered, heterogeneously dense or extremely dense).
How informed:
In the letter sent to patients after their mammogram. Patients with heterogeneously or extremely
dense breasts must receive the notification below.
Notification required:
"Your mammogram indicates that you have dense breast tissue. Dense breast tissue is relatively common and is
found in about forty percent (40%) of women. The presence of dense tissue can make it more difficult to detect
cancers in the breast by mammography because it can hide small abnormalities and may be associated with an increased risk. Hence,
you may benefit from supplementary screening tests, which may include a breast ultrasound screening, or a breast MRI examination,
or both, depending on your individual risk factors.
We are providing this information to raise your awareness of
this important factor and to encourage you to discuss your dense breast tissue, as well as other breast cancer risk factors, with your
health care provider. Together, you can decide which screening options are right for you.
A report of your results was sent to your physician. You should contact your physician
if you have any questions or concerns about this report."

South Carolina:

Effective date: 5/12/2016

Who receives: Law does not state specifically, but notes that "where applicable," the report must include the notification.
How informed: In the letter sent to patients after their mammograms.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician."

TENNESSEE:

Effective date: 1/1/2014

Who receives: Patient whose mammogram indicates dense breasts or extremely dense breasts.
How informed: The law states that the facility which performs the mammogram "shall provide" the notification, but does not specify how.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However,
dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased
risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform
your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results
was sent to your physician."

TEXAS:

Effective date: 9/1/2011

Who receives: All patients

How informed: The law does not require or specify that density information be included in the letter sent to patients after their mammogram. The law requires that upon the completion of a mammogram, a mammography facility shall "provide to the patients the following notice." How the information is provided to the patient is up to the mammography facility.
Notification required: (form of notification up to mammography facility):
"If your mammogram demonstrates that you have dense breast tissue, which could hide abnormalities, and you have other
risk factors for breast cancer that have been identified, you might benefit from supplemental screening tests that may be suggested
by your ordering physician.
Dense breast tissue, in and of itself, is a relatively common condition. Therefore,
this information is not provided to cause undue concern, but rather to raise your awareness and to promote discussion with your physician
regarding the presence of other risk factors, in addition to dense breast tissue.
A report of your mammography results will be sent to you and your physician. You should contact your physician if you have
any questions or concerns regarding this report."
Expanded Mammography Coverage (effective 9/1/2017): State law expands definition of "mammography" to include digital mammography or breast tomosynthesis (3D
mammograms). Check with your insurance company regarding details of your coverage.

UTAH:

Effective date: 5/8/2012

Who receives: Undetermined. The law does not require notification, but does encourage facilities to provide notice to patients
"with dense breast tissue" and to include such notification with the patient’s mammogram results.
The law suggests the following language "may be included":
"Mammography is the only breast cancer screening examination which has been shown in multiple randomized clinical trials to
reduce death rate from breast cancer. However, it is not a perfect test, specifically in women with dense breast tissue. Because
your mammogram demonstrates that you have dense breast tissue, you may benefit from supplementary screening tests, depending on
your personal risk factors and family history. Although other screening tests may find additional cancers, they may not necessarily
increase survival. Nevertheless, you should discuss your mammography results with your health care provider. A copy of your mammography
report has been sent to your health care provider's office. Please contact your health care provider if you have any questions or concerns
about this notice."

Vermont:

Effective date: This act shall take effect on July 1, 2016 and shall apply to exams performed on or after January 15, 2017.

Who receives: Every patient must receive information that identifies the patient's individual breast density classification. Patients with heterogeneously or extremely dense breasts must receive the notification below.
How informed: In the letter sent to patients after their mammograms.
Notification required:
The summary of the mammography report shall include a notice substantially similar to the following: "Your mammogram indicates that you have dense breast tissue. Dense breast tissue is a normal finding that is present in about 40 percent of women. Dense breast tissue can make it more difficult to detect cancer on a mammogram and may be associated with a slightly increased risk for breast cancer. This information is provided to raise your awareness of the impact of breast density on cancer detection and to encourage you to discuss this issue, as well as other breast cancer risk factors, with your health care provider as you decide together which screening options may be right for you."

VIRGINIA:

Effective date: 7/1/2012, but notification language was amended to the following effective 7/1/2013

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammogram.
Notification required: "Your mammogram demonstrates that you have dense breast tissue. Dense breast tissue is very common and is not abnormal. However,
dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer.
This information is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast
cancer. At that time, ask your doctor if more screening tests might be useful based on your risk.
A report of your mammography results has been sent to your referring physician’s office, and you should contact your
physician if you have any questions or concerns about this report."

Please note, bill language is not final language. A bill is often amended as it moves through the legislative process and therefore may not reflect the final language ultimately signed into law.

Colorado:

Effective date: 10/1/2017

Who receives: Patient whose mammogram indicates heterogeneously or extremely dense breasts.
How informed: In the letter sent to patients after their mammograms.
Notification required:
"Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician."

KansasBill Number: SB 407 (2012)

A bill was introduced in 2012 but did not progress and/or pass into law.

New HampshireBill Number: HB 1273

A bill was introduced but did not progress and/or pass into law by end of the 2016 legislative session.

Who receives: Every patient must receive information that identifies the patient's individual breast density classification (fatty, scattered,
heterogeneously dense or extremely dense). Patients with heterogeneously or extremely dense breasts shall receive a notice substantially similar to the
notification below.
How informed: In the letter sent to patients after their mammogram.
Notification required:
The summary of the mammography report shall include a notice substantially similar to the following: "Your mammogram indicates that you have dense breast
tissue. Dense breast tissue is a normal finding that is present in about forty percent of women. Dense breast tissue can make it more difficult to detect
cancer on a mammogram and may be associated with a slightly increased risk for breast cancer. This information is provided to raise your awareness of the
impact of breast density on cancer detection and to encourage you to discuss this issue, as well as other breast cancer risk factors, with your health care
provider as you decide together which screening options may be right for you."

A bill was introduced but did not progress and/or pass into law by end of the 2017 legislative session.

ARKANSAS:

Insurance: Effective date 8/3/2017 (estimated)

All women: An insurance policy shall not impose a copayment or deductible for a screening mammogram, including digital breast tomosynthesis (3D mammography).

Heterogeneously/Extremely Dense: "A comprehensive ultrasound screening of an entire breast or breasts if a mammogram screening demonstrates heterogeneously dense or extremely dense breast tissue when the woman’s primary healthcare provider or radiologist determines a comprehensive ultrasound screening is medically necessary." "A breast ultrasound may be subject to any applicable copayment as required under a health benefit plan but shall not be subject to a deductible."

"Insurance coverage for screening mammograms, including digital breast tomosynthesis (3D), and breast ultrasounds shall not prejudice coverage for diagnostic mammograms or breast ultrasounds as recommended by the woman’s physician."

The information provided on this website as it relates to state law is for general information purposes only. DenseBreast-info.org endeavors to provide an informed interpretation of the state laws as they relate to breast density; however, state legislative language varies and can be complex or vague. These codes may not be the most recent version; a state may have more current, amended or accurate information. No representations or warranties of any kind are made, express or implied, about the completeness, accuracy or reliability of the information or interpretation provided. Any reliance you place on such information is therefore strictly at your own risk. Specific questions about the laws in your state should be directed to your state legislature.